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The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

By |October 10, 2022|Chiropractic Management, Low Back Pain, Return To Work, Whiplash|

The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

The Chiro.Org Blog

SOURCE:   Disabil Rehabil 2015; 37 (20): 1808–1816

Amanda E Young, Elyssa Besen, YoonSun Choi

Liberty Mutual Research Institute for Safety,
Center for Disability Research,
Hopkinton, MA, USA.

Purpose: &nbsp Workers’ own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.

Method: &nbsp A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.

Results: &nbsp A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.

Conclusions: &nbsp Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker’s movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker’s expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker’s concerns. Once underling issues are identified, work can be put into resolving these so that the worker’s return to the workplace is not impeded.

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Who Will Have Sustainable Employment After a Back Injury?

By |June 1, 2019|Clinical Prediction Rule, Return To Work|

Who Will Have Sustainable Employment After a Back Injury? The Development of a Clinical Prediction Model in a Cohort of Injured Workers

The Chiro.Org Blog

SOURCE:   J Occup Rehabil. 2017 (Sep); 27 (3): 445–455

Heather M. Shearer, Pierre Cote, Eleanor Boyle, Jill A. Hayden, John Frank, William G. Johnson

UOIT-CMCC Center for the Study of Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology,
2000 Simcoe St. North,
Oshawa, ON, L1H 7K4, Canada.

Our objective was to develop a clinical prediction model to identify workers with sustainable employment following an episode of work-related low back pain (LBP).

Methods   We used data from a cohort study of injured workers with incident LBP claims in the USA to predict employment patterns 1 and 6 months following a workers’ compensation claim. We developed three sequential models to determine the contribution of three domains of variables:

(1)   basic demographic/clinical variables;

(2)   health-related variables; and

(3)   work-related factors.

Multivariable logistic regression was used to develop the predictive models. We constructed receiver operator curves and used the c-index to measure predictive accuracy.

Results   Seventy-nine percent and 77 % of workers had sustainable employment at 1 and 6 months, respectively. Sustainable employment at 1 month was predicted by initial back pain intensity, mental health-related quality of life, claim litigation and employer type (c-index = 0.77).

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Chiropractors Contribute to Work Disability Prevention

By |January 20, 2019|Chiropractic Care, Return To Work, Workers' Compensation|

Can Chiropractors Contribute to Work Disability Prevention Through Sickness Absence Management for Musculoskeletal Disorders? – A Comparative Qualitative Case Study in the Scandinavian Context

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2018 (Apr 26); 26: 15

Mette Jensen Stochkendahl, Ole Kristoffer Larsen, Casper Glissmann Nim, Iben Axén, Julia Haraldsson, Ole Christian Kvammen, and Corrie Myburgh

Nordic Institute of Chiropractic and Clinical Biomechanics,
Campusvej 55, DK-5230
Odense M, Denmark.

BACKGROUND:   Despite extensive publication of clinical guidelines on how to manage musculoskeletal pain and back pain in particular, these efforts have not significantly translated into decreases in work disability due to musculoskeletal pain. Previous studies have indicated a potential for better outcomes by formalized, early referral to allied healthcare providers familiar with occupational health issues. Instances where allied healthcare providers of comparable professional characteristics, but with differing practice parameters, can highlight important social and organisational strategies useful for informing policy and practice. Currently, Norwegian chiropractors have legislated sickness certification rights, whereas their Danish and Swedish counterparts do not. Against the backdrop of legislative variation, we described, compared and contrasted the views and experiences of Scandinavian chiropractors engaging in work disability prevention and sickness absence management.

METHODS:   This study was embedded in a two-phased, sequential exploratory mixed-methods design. In a comparative qualitative case study design, we explored the experience of chiropractors regarding sickness absence management drawn from face-to-face, semi-structured interviews. We subsequently coded and thematically restructured their experiences and perceptions.

RESULTS:   Twelve interviews were conducted. Thematically, chiropractors’ capacity to support patients in sickness absence management revolved around four key issues: issues of legislation and politics; the rationale for being a sickness absence management partner; whether an integrated sickness absence management pathway existed/could be created; and finally, the barriers to service provision for sickness absence management.

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Managing Sickness Absence of Patients

By |January 19, 2019|Return To Work, Workers' Compensation|

Managing Sickness Absence of Patients with Musculoskeletal Pain – A Cross-sectional Survey of Scandinavian Chiropractors

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2019 (Jan 11); 27: 1

Mette Jensen Stochkendahl, Casper Glissmann Nim, Eleanor Boyle, Ole Kristoffer Larsen, Iben Axén, Ole Christian Kvammen and Corrie Myburgh

Nordic Institute of Chiropractic and Clinical Biomechanics,
Campusvej 55, DK-5230
Odense M, Denmark.

BACKGROUND:   Musculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. This study aimed to determine the prevalence of musculoskeletal practitioners’ practice behaviours, and their perceptions and beliefs about sickness absence management by using Scandinavian chiropractors as an example, as well as to examine the association between these characteristics and two different practice behaviours.

METHODS:   As part of a mixed-methods study, we surveyed members of the national chiropractic associations in Denmark, Norway, and Sweden in 2016. Descriptive statistics were used to describe prevalence. Multilevel logistic regression with backwards stepping was used to estimate odds ratios with 95% confidence intervals between each of the two practice behaviours and the characteristics.

RESULTS:   Out of the 802 respondents (response rate 56%), 372 were Danish, 349 Norwegian, and 81 Swedish. In Denmark and Norway, 38.7 and 37.8% always/often considered if sick leave was appropriate for their patient compared to 21.0% in Sweden (p = 0.007); and 86.5% of the Norwegian chiropractors always/often recommended to return-to-work versus 64.5 and 66.7% in Denmark and Sweden respectively (p < 0.001). In the final models, factors associated with the two practice behaviours were age, level of clinical experience, working as a teacher, the tendency to be updated on current legislations and policies using social services, contact with general practitioners, relevance of engagement in SAM, consideration of workplace factors, SAM as part of the clinical tool box, patient out-of-pocket fee, and recommending fast return-to-work.

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A Prospective Cohort Study of the Impact of Return-to-Work

By |June 29, 2018|Return To Work|

A Prospective Cohort Study of the Impact of Return-to-Work Coordinators in Getting Injured Workers Back on the Job

The Chiro.Org Blog

SOURCE:   J Occup Rehabil. 2018 (Jun); 28 (2): 298–306

Tyler J. Lane, Rebbecca Lilley, Sheilah Hogg-Johnson, Anthony D. LaMontagne, Malcolm R. Sim, Peter M. Smith

Department of Epidemiology and Preventive Medicine,
School of Public Health and Preventive Medicine,
Monash University, Level 2,
553 St Kilda Road,
Melbourne, VIC, 3004, Australia.

Purpose   To assess the impact of workplace-based return-to-work (RTW) Coordinators’ interpersonal and functional activities on RTW outcomes.

Methods   Multivariable logistic regression analyses of cross-sectional and longitudinal survey responses of 632 injured workers with at least 10 days of work absence in Victoria, Australia, adjusting for demographic and other workplace factors. Outcome was being back at work for at least 1 month, measured at both baseline and 6 month follow-up survey. Participant responses to stressfulness of Coordinator interactions were dichotomised into good and poor and evaluated as a proxy for Coordinators’ interpersonal activities, while having a RTW plan was evaluated as a proxy for functional activities.

Results   At baseline, RTW plans doubled the odds of RTW (OR 2.02; 95% CI 1.40-2.90) and attenuated the impact of good Coordinator interactions (1.14; 0.77-1.70). At 6-month follow-up, the opposite was observed: good interactions nearly doubled odds of RTW (1.90; 1.22-2.95) while RTW plans were non-significant (1.02; 0.68-1.54).

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Factors Affecting Return To Work After Injury Or Illness:
Best Evidence Synthesis of Systematic Reviews

By |September 15, 2016|Return To Work|

Factors Affecting Return To Work After Injury Or Illness: Best Evidence Synthesis of Systematic Reviews

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2016 (Sep 8)

Carol Cancelliere, James Donovan,
Mette Jensen Stochkendahl, Melissa Biscardi,
Carlo Ammendolia, Corrie Myburgh and J. David Cassidy

Institute of Health Policy,
Management and Evaluation,
Dalla Lana School of Public Health,
University of Toronto,
Toronto, Ontario Canada

BACKGROUND:   Work disability is a major personal, financial and public health burden. Predicting future work success is a major focus of research.

OBJECTIVES:   To identify common prognostic factors for return-to-work across different health and injury conditions and to describe their association with return-to-work outcomes.

METHODS:   Medline, Embase, PsychINFO, Cinahl, and Cochrane Database of Systematic Reviews and the grey literature were searched from January 1, 2004 to September 1, 2013. Systematic reviews addressing return-to-work in various conditions and injuries were selected. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria to identify low risk of bias reviews.

RESULTS:   Of the 36,193 titles screened and the 94 eligible studies reviewed, 56 systematic reviews were accepted as low risk of bias. Over half of these focused on musculoskeletal disorders, which were primarily spine related (e.g., neck and low back pain). The other half of studies assessed workers with mental health or cardiovascular conditions, stroke, cancer, multiple sclerosis or other non-specified health conditions. Many factors have been assessed, but few consistently across conditions. Common factors associated with positive return-to-work outcomes were higher education and socioeconomic status, higher self-efficacy and optimistic expectations for recovery and return-to-work, lower severity of the injury/illness, return-to-work coordination, and multidisciplinary interventions that include the workplace and stakeholders. Common factors associated with negative return-to-work outcomes were older age, being female, higher pain or disability, depression, higher physical work demands, previous sick leave and unemployment, and activity limitations.

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